DSM-5 Attenuated Psychosis Syndrome in Adolescents Hospitalized With Non-psychotic Psychiatric Disorders

Gonzalo Salazar de Pablo; Daniel Guinart; Barbara A. Cornblatt; Andrea M. Auther; Ricardo E. Carrión; Maren Carbon; Sara Jiménez-Fernández; Ditte L. Vernal; Susanne Walitza; Miriam Gerstenberg; Riccardo Saba; Nella Lo Cascio; Martina Brandizzi; Celso Arango; Carmen Moreno; Anna Van Meter; Paolo Fusar-Poli; Christoph U. Correll

doi:10.3389/fpsyt.2020.568982

DSM-5 Attenuated Psychosis Syndrome in Adolescents Hospitalized With Non-psychotic Psychiatric Disorders

Gonzalo Salazar de Pablo, Daniel Guinart, Barbara A. Cornblatt, Andrea M. Auther, Ricardo E. Carrión, Maren Carbon, Sara Jiménez-Fernández, Ditte L. Vernal, Susanne Walitza, Miriam Gerstenberg, Riccardo Saba, Nella Lo Cascio, Martina Brandizzi, Celso Arango, Carmen Moreno, Anna Van Meter, Paolo Fusar-Poli, Christoph U. Correll^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

9 Citations (Scopus)

Abstract

Introduction: Although attenuated psychotic symptoms often occur for the first time during adolescence, studies focusing on adolescents are scarce. Attenuated psychotic symptoms form the criteria to identify individuals at increased clinical risk of developing psychosis. The study of individuals with these symptoms has led to the release of the DSM-5 diagnosis of Attenuated Psychosis Syndrome (APS) as a condition for further research. We aimed to characterize and compare hospitalized adolescents with DSM-5-APS diagnosis vs. hospitalized adolescents without a DSM-5-APS diagnosis. Methods: Interviewing help-seeking, hospitalized adolescents (aged 12–18 years) and their caregivers independently with established research instruments, we (1) evaluated the presence of APS among non-psychotic adolescents, (2) characterized and compared APS and non-APS individuals regarding sociodemographic, illness and intervention characteristics, (3) correlated psychopathology with levels of functioning and severity of illness and (4) investigated the influence of individual clinical, functional and comorbidity variables on the likelihood of participants to be diagnosed with APS. Results: Among 248 consecutively recruited adolescents (age=15.4 ± 1.5 years, females = 69.6%) with non-psychotic psychiatric disorders, 65 (26.2%) fulfilled APS criteria and 183 (73.8%) did not fulfill them. Adolescents with APS had higher number of psychiatric disorders than non-APS adolescents (3.5 vs. 2.4, p < 0.001; Cohen's d = 0.77), particularly, disruptive behavior disorders (Cramer's V = 0.16), personality disorder traits (Cramer's V = 0.26), anxiety disorders (Cramer's V = 0.15), and eating disorders (Cramer's V = 0.16). Adolescents with APS scored higher on positive (Cohen's d = 1.5), negative (Cohen's d = 0.55), disorganized (Cohen's d = 0.51), and general symptoms (Cohen's d = 0.84), and were more severely ill (Cohen's d = 1.0) and functionally impaired (Cohen's d = 0.31). Negative symptoms were associated with lower functional levels (Pearson ρ = −0.17 to −0.20; p = 0.014 to 0.031). Global illness severity was associated with higher positive, negative, and general symptoms (Pearson ρ = 0.22 to 0.46; p = 0.04 to p < 0.001). APS status was independently associated with perceptual abnormalities (OR = 2.0; 95% CI = 1.6–2.5, p < 0.001), number of psychiatric diagnoses (OR = 1.5; 95% CI = 1.2–2.0, p = 0.002), and impaired stress tolerance (OR = 1.4; 95% CI = 1.1–1.7, p = 0.002) (r² = 0.315, p < 0.001). Conclusions: A considerable number of adolescents hospitalized with non-psychotic psychiatric disorders meet DSM-5-APS criteria. These help-seeking adolescents have more comorbid disorders and more severe symptoms, functional impairment, and severity of illness than non-APS adolescents. Thus, they warrant high intensity clinical care.

Original language	English
Article number	568982
Journal	Frontiers in Psychiatry
Volume	11
DOIs	https://doi.org/10.3389/fpsyt.2020.568982
Publication status	Published - 21 Oct 2020

Keywords

adolescence
Attenuated Psychosis Syndrome (APS)
epidemiology
prevention
psychosis
risk

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.3389/fpsyt.2020.568982

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Salazar de Pablo, G., Guinart, D., Cornblatt, B. A., Auther, A. M., Carrión, R. E., Carbon, M., Jiménez-Fernández, S., Vernal, D. L., Walitza, S., Gerstenberg, M., Saba, R., Lo Cascio, N., Brandizzi, M., Arango, C., Moreno, C., Van Meter, A., Fusar-Poli, P., & Correll, C. U. (2020). DSM-5 Attenuated Psychosis Syndrome in Adolescents Hospitalized With Non-psychotic Psychiatric Disorders. Frontiers in Psychiatry, 11, Article 568982. https://doi.org/10.3389/fpsyt.2020.568982

@article{1563df6b95014d28b6f760eb6bc54a99,

title = "DSM-5 Attenuated Psychosis Syndrome in Adolescents Hospitalized With Non-psychotic Psychiatric Disorders",

abstract = "Introduction: Although attenuated psychotic symptoms often occur for the first time during adolescence, studies focusing on adolescents are scarce. Attenuated psychotic symptoms form the criteria to identify individuals at increased clinical risk of developing psychosis. The study of individuals with these symptoms has led to the release of the DSM-5 diagnosis of Attenuated Psychosis Syndrome (APS) as a condition for further research. We aimed to characterize and compare hospitalized adolescents with DSM-5-APS diagnosis vs. hospitalized adolescents without a DSM-5-APS diagnosis. Methods: Interviewing help-seeking, hospitalized adolescents (aged 12–18 years) and their caregivers independently with established research instruments, we (1) evaluated the presence of APS among non-psychotic adolescents, (2) characterized and compared APS and non-APS individuals regarding sociodemographic, illness and intervention characteristics, (3) correlated psychopathology with levels of functioning and severity of illness and (4) investigated the influence of individual clinical, functional and comorbidity variables on the likelihood of participants to be diagnosed with APS. Results: Among 248 consecutively recruited adolescents (age=15.4 ± 1.5 years, females = 69.6%) with non-psychotic psychiatric disorders, 65 (26.2%) fulfilled APS criteria and 183 (73.8%) did not fulfill them. Adolescents with APS had higher number of psychiatric disorders than non-APS adolescents (3.5 vs. 2.4, p < 0.001; Cohen's d = 0.77), particularly, disruptive behavior disorders (Cramer's V = 0.16), personality disorder traits (Cramer's V = 0.26), anxiety disorders (Cramer's V = 0.15), and eating disorders (Cramer's V = 0.16). Adolescents with APS scored higher on positive (Cohen's d = 1.5), negative (Cohen's d = 0.55), disorganized (Cohen's d = 0.51), and general symptoms (Cohen's d = 0.84), and were more severely ill (Cohen's d = 1.0) and functionally impaired (Cohen's d = 0.31). Negative symptoms were associated with lower functional levels (Pearson ρ = −0.17 to −0.20; p = 0.014 to 0.031). Global illness severity was associated with higher positive, negative, and general symptoms (Pearson ρ = 0.22 to 0.46; p = 0.04 to p < 0.001). APS status was independently associated with perceptual abnormalities (OR = 2.0; 95% CI = 1.6–2.5, p < 0.001), number of psychiatric diagnoses (OR = 1.5; 95% CI = 1.2–2.0, p = 0.002), and impaired stress tolerance (OR = 1.4; 95% CI = 1.1–1.7, p = 0.002) (r2 = 0.315, p < 0.001). Conclusions: A considerable number of adolescents hospitalized with non-psychotic psychiatric disorders meet DSM-5-APS criteria. These help-seeking adolescents have more comorbid disorders and more severe symptoms, functional impairment, and severity of illness than non-APS adolescents. Thus, they warrant high intensity clinical care.",

keywords = "adolescence, Attenuated Psychosis Syndrome (APS), epidemiology, prevention, psychosis, risk",

author = "{Salazar de Pablo}, Gonzalo and Daniel Guinart and Cornblatt, {Barbara A.} and Auther, {Andrea M.} and Carri{\'o}n, {Ricardo E.} and Maren Carbon and Sara Jim{\'e}nez-Fern{\'a}ndez and Vernal, {Ditte L.} and Susanne Walitza and Miriam Gerstenberg and Riccardo Saba and {Lo Cascio}, Nella and Martina Brandizzi and Celso Arango and Carmen Moreno and {Van Meter}, Anna and Paolo Fusar-Poli and Correll, {Christoph U.}",

year = "2020",

month = oct,

day = "21",

doi = "10.3389/fpsyt.2020.568982",

language = "English",

volume = "11",

journal = "Frontiers in Psychiatry",

issn = "1664-0640",

publisher = "Frontiers",

}

Salazar de Pablo, G, Guinart, D, Cornblatt, BA, Auther, AM, Carrión, RE, Carbon, M, Jiménez-Fernández, S, Vernal, DL, Walitza, S, Gerstenberg, M, Saba, R, Lo Cascio, N, Brandizzi, M, Arango, C, Moreno, C, Van Meter, A, Fusar-Poli, P & Correll, CU 2020, 'DSM-5 Attenuated Psychosis Syndrome in Adolescents Hospitalized With Non-psychotic Psychiatric Disorders', Frontiers in Psychiatry, vol. 11, 568982. https://doi.org/10.3389/fpsyt.2020.568982

TY - JOUR

T1 - DSM-5 Attenuated Psychosis Syndrome in Adolescents Hospitalized With Non-psychotic Psychiatric Disorders

AU - Salazar de Pablo, Gonzalo

AU - Guinart, Daniel

AU - Cornblatt, Barbara A.

AU - Auther, Andrea M.

AU - Carrión, Ricardo E.

AU - Carbon, Maren

AU - Jiménez-Fernández, Sara

AU - Vernal, Ditte L.

AU - Walitza, Susanne

AU - Gerstenberg, Miriam

AU - Saba, Riccardo

AU - Lo Cascio, Nella

AU - Brandizzi, Martina

AU - Arango, Celso

AU - Moreno, Carmen

AU - Van Meter, Anna

AU - Fusar-Poli, Paolo

AU - Correll, Christoph U.

PY - 2020/10/21

Y1 - 2020/10/21

N2 - Introduction: Although attenuated psychotic symptoms often occur for the first time during adolescence, studies focusing on adolescents are scarce. Attenuated psychotic symptoms form the criteria to identify individuals at increased clinical risk of developing psychosis. The study of individuals with these symptoms has led to the release of the DSM-5 diagnosis of Attenuated Psychosis Syndrome (APS) as a condition for further research. We aimed to characterize and compare hospitalized adolescents with DSM-5-APS diagnosis vs. hospitalized adolescents without a DSM-5-APS diagnosis. Methods: Interviewing help-seeking, hospitalized adolescents (aged 12–18 years) and their caregivers independently with established research instruments, we (1) evaluated the presence of APS among non-psychotic adolescents, (2) characterized and compared APS and non-APS individuals regarding sociodemographic, illness and intervention characteristics, (3) correlated psychopathology with levels of functioning and severity of illness and (4) investigated the influence of individual clinical, functional and comorbidity variables on the likelihood of participants to be diagnosed with APS. Results: Among 248 consecutively recruited adolescents (age=15.4 ± 1.5 years, females = 69.6%) with non-psychotic psychiatric disorders, 65 (26.2%) fulfilled APS criteria and 183 (73.8%) did not fulfill them. Adolescents with APS had higher number of psychiatric disorders than non-APS adolescents (3.5 vs. 2.4, p < 0.001; Cohen's d = 0.77), particularly, disruptive behavior disorders (Cramer's V = 0.16), personality disorder traits (Cramer's V = 0.26), anxiety disorders (Cramer's V = 0.15), and eating disorders (Cramer's V = 0.16). Adolescents with APS scored higher on positive (Cohen's d = 1.5), negative (Cohen's d = 0.55), disorganized (Cohen's d = 0.51), and general symptoms (Cohen's d = 0.84), and were more severely ill (Cohen's d = 1.0) and functionally impaired (Cohen's d = 0.31). Negative symptoms were associated with lower functional levels (Pearson ρ = −0.17 to −0.20; p = 0.014 to 0.031). Global illness severity was associated with higher positive, negative, and general symptoms (Pearson ρ = 0.22 to 0.46; p = 0.04 to p < 0.001). APS status was independently associated with perceptual abnormalities (OR = 2.0; 95% CI = 1.6–2.5, p < 0.001), number of psychiatric diagnoses (OR = 1.5; 95% CI = 1.2–2.0, p = 0.002), and impaired stress tolerance (OR = 1.4; 95% CI = 1.1–1.7, p = 0.002) (r2 = 0.315, p < 0.001). Conclusions: A considerable number of adolescents hospitalized with non-psychotic psychiatric disorders meet DSM-5-APS criteria. These help-seeking adolescents have more comorbid disorders and more severe symptoms, functional impairment, and severity of illness than non-APS adolescents. Thus, they warrant high intensity clinical care.

AB - Introduction: Although attenuated psychotic symptoms often occur for the first time during adolescence, studies focusing on adolescents are scarce. Attenuated psychotic symptoms form the criteria to identify individuals at increased clinical risk of developing psychosis. The study of individuals with these symptoms has led to the release of the DSM-5 diagnosis of Attenuated Psychosis Syndrome (APS) as a condition for further research. We aimed to characterize and compare hospitalized adolescents with DSM-5-APS diagnosis vs. hospitalized adolescents without a DSM-5-APS diagnosis. Methods: Interviewing help-seeking, hospitalized adolescents (aged 12–18 years) and their caregivers independently with established research instruments, we (1) evaluated the presence of APS among non-psychotic adolescents, (2) characterized and compared APS and non-APS individuals regarding sociodemographic, illness and intervention characteristics, (3) correlated psychopathology with levels of functioning and severity of illness and (4) investigated the influence of individual clinical, functional and comorbidity variables on the likelihood of participants to be diagnosed with APS. Results: Among 248 consecutively recruited adolescents (age=15.4 ± 1.5 years, females = 69.6%) with non-psychotic psychiatric disorders, 65 (26.2%) fulfilled APS criteria and 183 (73.8%) did not fulfill them. Adolescents with APS had higher number of psychiatric disorders than non-APS adolescents (3.5 vs. 2.4, p < 0.001; Cohen's d = 0.77), particularly, disruptive behavior disorders (Cramer's V = 0.16), personality disorder traits (Cramer's V = 0.26), anxiety disorders (Cramer's V = 0.15), and eating disorders (Cramer's V = 0.16). Adolescents with APS scored higher on positive (Cohen's d = 1.5), negative (Cohen's d = 0.55), disorganized (Cohen's d = 0.51), and general symptoms (Cohen's d = 0.84), and were more severely ill (Cohen's d = 1.0) and functionally impaired (Cohen's d = 0.31). Negative symptoms were associated with lower functional levels (Pearson ρ = −0.17 to −0.20; p = 0.014 to 0.031). Global illness severity was associated with higher positive, negative, and general symptoms (Pearson ρ = 0.22 to 0.46; p = 0.04 to p < 0.001). APS status was independently associated with perceptual abnormalities (OR = 2.0; 95% CI = 1.6–2.5, p < 0.001), number of psychiatric diagnoses (OR = 1.5; 95% CI = 1.2–2.0, p = 0.002), and impaired stress tolerance (OR = 1.4; 95% CI = 1.1–1.7, p = 0.002) (r2 = 0.315, p < 0.001). Conclusions: A considerable number of adolescents hospitalized with non-psychotic psychiatric disorders meet DSM-5-APS criteria. These help-seeking adolescents have more comorbid disorders and more severe symptoms, functional impairment, and severity of illness than non-APS adolescents. Thus, they warrant high intensity clinical care.

KW - adolescence

KW - Attenuated Psychosis Syndrome (APS)

KW - epidemiology

KW - prevention

KW - psychosis

KW - risk

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U2 - 10.3389/fpsyt.2020.568982

DO - 10.3389/fpsyt.2020.568982

M3 - Article

AN - SCOPUS:85095691034

SN - 1664-0640

VL - 11

JO - Frontiers in Psychiatry

JF - Frontiers in Psychiatry

M1 - 568982

ER -

DSM-5 Attenuated Psychosis Syndrome in Adolescents Hospitalized With Non-psychotic Psychiatric Disorders

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